Alcoholism is a disease in which person lose control over the amount of consumed alcohol. The problem of alcohol abuse in Poland concerns about 9% of the population. One of the treatment methods is disulfiram therapy, which is associated with the risk of disulfiram-alcohol reaction. Due to many negative reports of side effects and questionable efficacy, this drug is nowadays rare used.
We present a case of a patient who had a disulfiram reaction due to alcohol consumption during disulfiram therapy

Baltaziak, Katarzyna

Brożyna, Klaudia

Ciechański, Krystian Lech

Kędziora, Aleksandra

Tchórz, Michał

Tkaczyk, Jędrzej

Journal of Education Health and Sport

English

Akademicka Platforma Czasopism

Ciechański Krystian, Tkaczyk Jędrzej, Brożyna Klaudia, Kędziora Aleksandra, Baltaziak Katarzyna, Tchórz Michał. Disulfiram-alcohol  reaction  in  49  year  old  patient.  Journal  of  Education,  Health  and  Sport.  2018;8(9):911-916  eISNN  2391-8306.  DOIhttp://dx.doi.org/10.5281/zenodo.1419193http://ojs.ukw.edu.pl/index.php/johs/article/view/5997The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017).1223 Journal of Education, Health and Sport eissn 2391-8306 7© The Authors 2018;This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, PolandOpen Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium,provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike.(http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.The authors declare that there is no conflict of interests regarding the publication of this paper.Received: 22.08.2018. Revised: 28.08.2018. Accepted: 14.09.2018.Disulfiram-alcohol reaction in 49 year old patientKrystian Ciechański1, Jędrzej Tkaczyk1, Klaudia Brożyna1,Aleksandra Kędziora2, Katarzyna Baltaziak2, Michał Tchórz31Student’s Research Group at the Department of Toxicology, MedicalUniversity of Lublin2 Student’s Research Group at Chair and Department of Epidemiology andClinical Research Methodology, Medical University of Lublin 3Department of Toxicology, Medical University of LublinAbstractAlcoholism is a disease in which person lose control over the amount of consumedalcohol.  The  problem  of  alcohol  abuse  in  Poland  concerns  about  9%  of  thepopulation. One of the treatment methods is disulfiram therapy, which is associatedwith the risk of  disulfiram-alcohol  reaction.  Due to many negative reports of  sideeffects and questionable efficacy, this drug is nowadays rare used.We  present  a  case  of  a  patient  who  had  a  disulfiram reaction  due  to  alcoholconsumption during disulfiram therapy.Key words: alcoholism, disulfiram, DERIntroductionAlcoholism is a disease in which person lose control over the amount of consumedalcohol.It is estimated that in Poland the problem of alcoholism and harmful drinkers affectsapproximately 3.3 million people, which is approximately 9% of the population. Only911about  150 000 addicts  undergo alcohol  treatment.  The most  important  treatmentmethod is to maintain abstinence, which is attempted to achieve through variousforms: psychotherapy, support groups or pharmacotherapy. Disulfiram is nowadaysrarely used [3].Effect of disulfiram on the body was for the first time observed in the 1930s. At thattime, the workers of the vulcanization industry who were exposed to this substancefelt  ill  shortly  after  drinking  alcohol.  This  symptoms  included  flushing,  nausea,dizziness,  headache  and  hypotension.  In  the  later  years,  a  number  of  thesesymptoms were called the disulfiram reaction [4]. For medical purposes, disulfiramwas first used at the turn of 1940/1950 and was the first drug registered by the FDA(Food and Drug Administration) in USA for the treatment of alcoholism [5].We  present  a  case  of  a  patient  who  had  a  disulfiram reaction  due  to  alcoholconsumption during disulfiram therapy.Case reportA 49 year old man, who had been addicted to alcohol for many years, was admittedto the Clinical Toxicology and Cardiology Department due to progressive weakness,tachycardia, anxiety, dyspnoea, hotness, headache and palpitations. The interviewshowed that two weeks earlier, the patient had implanted a subcutaneous prolongedrelease tablet. In the past, the patient several times went on a rehab treatment, butquickly resigned and returned to addiction. Patient admitted to drinking alcohol onthat  day.  The  exact  amount  of  drunk  alcohol  was  unknown.  He  was  in  logicalcontact,  circulatory  and  respiratory  effective.  In  the  examination  hypertension(150/105 mmHg), tachycardia (HR=100/min), visible reddening of the upper half ofthe body were found. Laboratory tests revealed a concentration of ethanol- 3.24 g/land indicators of liver damage (AST- 99 U/I,  ALT 87 U/I).  Basing on the history,clinical  picture  and  laboratory  tests,  disulfiram  reaction  was  diagnosed.  Duringhospitalization iron preparation, vitamin C and  multi electrolyte fluids were used tocompensate electrolyte disturbances. After three days of hospitalization, the patientwas signed off the hospital in a general good condition with the recommendation ofattendance a rehabilitation treatment in a closed unit.DiscussionDisulfiram works by blocking one of the routes of alcohol metabolism. After ingestion,ethanol is converted to acetaldehyde by alcohol dehydrogenase. The toxic aldehydeis  then  converted  to  less  harmful  acetic  acid  by  the  action  of  aldehydedehydrogenase. This last transformation is blocked by disulfiram [6]. The scheme ofaction  of  the  drug  is  shown  in  Figure  1.  As  a  result,  the  concentration  ofacetaldehyde  increases,  which  affects  the  central  nervous  system,  inhibiting  β-hydroxylase  of  dopamine  and  affecting  the  serotoninergic  conduction.  This912mechanism is responsible for symptoms from nervous system such as convulsionsof  psychosis.  The  high  concentration of  acetaldehyde  also  contributes  todegranulation of mast cells and the release of histamine responsible for the heat andredness of the skin [7]. Possible effects of disulfiram reaction are shown in Table 1[5].  The  disulfiram-alcohol  reaction  usually  starts  10  to  30  minutes  after  alcoholconsumption and its intensity is proportional to the amount of alcohol consumed andthe  concentration of the disulfiram in  the blood.  Slight  symptoms may appear  atconcentration of 0.05 g/l ethanol in the blood and a serious 1.25-1.5 g/l [5]. Figure 1. Disulfiram interaction in metabolism of alcohol.Body Part Affected Moderate symptoms Severe symptomsBody skin Sweating  Warmth  andflushing,  particularly  onupper chest and faceNoneRespiratory system HyperventilationRespiratorydifficulty/dyspneaRespiratory depressionHead, neck, throat Acetaldehyde breath odorBlurred  vision  Head  andneck throbbing ThirstNoneStomach,  digestivesystemNausea/vomiting NoneChest,  heart,  circulatorysystemChest  pain/palpitationsHypotension TachycardiaCardiovascular  collapseArrhythmia  Myocardialinfarction  (in  individualswith  preexisting  coronaryartery  disease)  Acutecongestive  heart  failure(in  individuals  withpreexisting  myocardialdysfunction)Brain/nervous system Vertigo  Syncope  Markeduneasiness ConfusionSeizuresOther Weakness Death913Table 1. Possible effects of disulfiram reactionFirst clinical trials with disulfiram showed excellent results in most cases. However,nowadays some mistakes are pointed to these researches. They concern lack ofcontrol  group or  the  absence of  a  blank test,  which  reduces the value  of  theseexperiments. In addition, initially, when disulfiram began to be used, the doses weresignificantly  higher  (1000  mg-  3000  mg)  than  at  present  (250  mg-  500  mg).  Itresulted in more reports of toxicity, psychosis episodes and even death caused bydisulfiram reaction that time [8-10].The  accumulation  of  toxic  metabolites  of  ethanol  results  in  life-threateningsymptoms. So, the treatment of disulfiram is based on the fear of patient againstadverse  symptoms  after  drinking  alcohol.  This  mechanism  is  supposed  to  beresponsible for maintaining abstinence. Providing organism even the least alcoholdose may cause unpleasant symptoms that can even lead to death [3]. However, itoften  happens  that  a  large  group  of  addicted  patients  discontinues  disulfiramtreatment before planned drinking, while others try low doses of alcohol to test theirseverity and whether a disulfiram reaction will occur at all. These are one of the mainreasons for aborting treatment and abstinence [11]. In addition, it is believed that25% to 75% of patients who are in the course of disulfiram therapy consume alcohol[12].In Poland two forms of disulfiram are registered to use: oral tablets, and prolongedrelease  tablets  for  subcutaneous  implantation.  Disulfiram  implants  are  a  highly-chosen  method  of  alcoholism  treatment  and  are  used  in  specific  cases.  Aquestionnaire  survey  carried  out  by  the  State  Agency  for  Prevention  of  AlcoholRelated Problems [13] shows that disulfiram in oral form is used in almost 30% ofcases  and  the  form  of  implants  in  just  over  7% of  all  medications available  intreatment of alcoholism in Poland. As it is shown above, subcutaneous form is usedquite rarely, which may be associated with low efficacy of this therapy [3]. Bergstromet al.  [14] claim that classical implantation of disulfiram does not provide enoughlevel of medicine in the blood that would ensure the occurrence of disulfiram-alcoholreaction. In addition, according to Wilson's study [15] there are no clear differencesin the frequency and manner of drinking among patients who were implanted  with800 mg, 1200 mg or 1600 mg of disulfiram. However, it has been proven that dosesof over 1000 mg significantly increase the risk of local complications (abscesses).In the presented case, patient had a concentration of alcohol in blood at level of 3.24g/l.  Due to lack of standards for monitoring the concentration of disulfiram in theblood, the level of the drug at the time of alcohol  consumption can not be clearlydetermined.  The  patient  presented  typical  symptoms  of  disulfiram  syndrome.Fortunately, the symptoms did not pose a direct threat to life and due to performedtreatment, symptoms resolved and patient's condition stabilized.Indications for disulfiram-alcohol reaction among alcohol addicts are following: 500-9141000  mg  of  vitamin C  and  40-100  mg  of  iron  i.v.  This  procedure  immediatelyinterrupts the action of aldehyde dehydrogenase and the symptoms associated withexcessive level of acetaldehyde [16]. It  must  be  noted  that  disulfiram  should  not  be  assigned  as  monotherapy  ofalcoholism. It may be an addition in psychosocial therapy to reduce desire of drinking(as a negative stimulus),  in  a group of  patients  who are determined to  maintainabstinence, agree to take medications and have no contraindications to its use. It isalso  believed that in order to reduce number of complications, patients should beaccurately  qualified for treatment, eg. by eliminating people with seizures, suicidalattempts of cardiovascular disease [11].In conclusion, disulfiram therapy is not an alternative, but one of the elements ofcomprehensive treatment  of  an  addict.  Numerous  reports  of  side  effects  and  ofquestionable  effectiveness,  result  in  the  increasingly  rare  use  of  disulfiram  anddisplacement by newer drugs with fewer side effects.  Disulfiram therapy may beconsidered and used in a well-defined group of patients including indications (i.e.motivation and strong will), contraindications, monitoring of sobriety and regularity intaking medicine.References1. http://www.parpa.pl/index.php/33-analizy-badania-raporty/132-statystyki  (dostęp 10.09.2018). (in Polish).2. Wojnar M, Ślufarska A, Jakubczyk A,  Nawroty w uzależnieniu od alkoholuCzęść 1: Definicje i modele. Alkoholizm i Narkomania. 2006; 19(4): 379-394.(in Polish).3. Wnuk  M,  Marcinkowski  JT.  Alkoholizm–przegląd  koncepcji  oraz  metodleczenia. Hygeia Public Health, 2012; 1(47): 49-55. (in Polish).4. Kitson TM. The disulfiram–ethanol reaction. J Stud Alcohol. 1977; 38: 96–113.5. Incorporating  Alcohol  Pharmacotherapies  Into  Medical  Practice.  Series  49.Rockville:  Substance  Abuse  and  Mental  Health  Services  Administration;2009;15-25.6. Deitrich  RA,  Erwin  VG.  Mechanism  of  the  inhibition  of  aldehydedehydrogenasein  vivo  by  disulfiram  and  diethyldithiocarbamate.  Mol  Pharmacol.1971;May;7(3): 301-7.7. Berg  S,  Garbe  G,  Hirtz  J.  [The  effect  of  ethanol  andantabus-antabus-alcohol-reaction on histamine and mast cell. Contents of thelung  (author's transl)]. Z Rechtsmed. 1977; Mar 23;79(2):115-23. (in German).9158. Fuller  RK,  Gordis  E.  Does  disulfiram have  a  role  in  alcoholism treatmenttoday? Addiction. 2004; Jan;99(1): 21-4.9. Brewer C. How effective is the standard dose of disulfiram? A review of thealcohol-disulfiram reaction in practice. Br J Psychiatry. 1984; Feb;144:200-2.10.Amadoe,  Gazdar A.  Sudden death during disulfiram--alcohol  reaction. Q JStudAlcohol. 1967; Dec;28(4):649-54.11.Habrat  B.  Kontrowersje  dotyczące  leczenia  disulfiramem.  Alkoholizm  iNarkomania. 1994; 1(15): 9-18.12.Brewer  C.  Controlled  trials  of  Antabuse  in  alcoholism:  the  importance  ofsupervision and adequate dosage. Acta Psychiatr Scand Suppl. 1992;369:51-8.13.Farmakoterapia  w  praktyce  klinicznej  placówek  leczenia  uzależnienia  odalkoholu  (omówienie  wyników  badania  ankietowego).  Państwowa  AgencjaRozwiązywania  Problemów  Alkoholowych.  Warszawa:  marzec  2012.  (inPolish).14.Bergström B, Ohlin H, Lindblom PE, Wadstein J.  Is disulfiram implantationeffective? Lancet. 1982; Jan 2;1(8262):49-50.15.Wilson  A,  Blanchard  R,  Davidson  W,  McRae  L,  Maini  K.  Disulfiramimplantation:  a dose response trial. 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Disulfiram-alcohol reaction in 49 year old patient

Alcoholism is a disease in which person lose control over the amount of consumed alcohol. The problem of alcohol abuse in Poland concerns about 9% of the population. One of the treatment methods is disulfiram therapy, which is associated with the risk of disulfiram-alcohol reaction. Due to many negative reports of side effects and questionable efficacy, this drug is nowadays rare used.

We present a case of a patient who had a disulfiram reaction due to alcohol consumption during disulfiram therapy

Krystian Lech Ciechański

Jędrzej Tkaczyk

Klaudia Brożyna

Aleksandra Kędziora

Katarzyna Baltaziak

Michał Tchórz

Directory of Open Access Journals

Ciechański Krystian, Tkaczyk Jędrzej, Brożyna Klaudia, Kędziora Aleksandra, Baltaziak Katarzyna, Tchórz Michał. Disulfiram-alcohol reaction in 49 year old patient. Journal of Education, Health and Sport. 2018;8(9):911-916 eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1419193

http://ojs.ukw.edu.pl/index.php/johs/article/view/5997

https://pbn.nauka.gov.pl/sedno-webapp/works/877536

 

 

 

 

 

The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017).

1223 Journal of Education, Health and Sport eissn 2391-8306 7

 

© The Authors 2018;

This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland

Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike.

(http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.

 

The authors declare that there is no conflict of interests regarding the publication of this paper.

 

Received: 22.08.2018. Revised: 28.08.2018. Accepted: 14.09.2018.

 

 

 

 

 

Disulfiram-alcohol reaction in 49 year old patient

 

Krystian Ciechański1, Jędrzej Tkaczyk1, Klaudia Brożyna1,

Aleksandra  Kędziora2, Katarzyna Baltaziak2, Michał Tchórz3

 

1Student’s Research Group at the Department of Toxicology, Medical University of Lublin

2 Student’s Research Group at Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin 

3Department of Toxicology, Medical University of Lublin

 

 

Abstract

 

Alcoholism is a disease in which person lose control over the amount of consumed alcohol. The problem of alcohol abuse in Poland concerns about 9% of the population. One of the treatment methods is disulfiram therapy, which is associated with the risk of disulfiram-alcohol reaction. Due to many negative reports of side effects and questionable efficacy, this drug is nowadays rare used.

We present a case of a patient who had a disulfiram reaction due to alcohol consumption during disulfiram therapy.

 

Key words: alcoholism, disulfiram, DER

 

Introduction

 

Alcoholism is a disease in which person lose control over the amount of consumed alcohol.

It is estimated that in Poland the problem of alcoholism and harmful drinkers affects approximately 3.3 million people, which is approximately 9% of the population. Only about 150 000 addicts undergo alcohol treatment. The most important treatment method is to maintain abstinence, which is attempted to achieve through various forms: psychotherapy, support groups or pharmacotherapy. Disulfiram is nowadays rarely used [3].

Effect of disulfiram on the body was for the first time observed in the 1930s. At that time, the workers of the vulcanization industry who were exposed to this substance felt ill shortly after drinking alcohol. This symptoms included flushing, nausea, dizziness, headache and hypotension. In the later years, a number of these symptoms were called the disulfiram reaction [4]. For medical purposes, disulfiram was first used at the turn of 1940/1950 and was the first drug registered by the FDA (Food and Drug Administration) in USA for the treatment of alcoholism [5].

We present a case of a patient who had a disulfiram reaction due to alcohol consumption during disulfiram therapy

Ciechański, Krystian

NEUROSURGERY ENTHUSIASTIC WOMEN SOCIETY

http://www.ojs.ukw.edu.pl/index.php/johs/article/download/5997/7689

Disulfiram-alcohol reaction in 49 year old patient

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NEUROSURGERY ENTHUSIASTIC WOMEN SOCIETY